Presentation
This patient attends medical outpatient clinics in two specialties.
Patient Data
There is bilateral volume loss due to pulmonary fibrosis with an upper zone predilection.
CT demonstrates upper and mid zone fibrosis bilaterally with extensive bullous change. Syndesmophytes and vertebral body squaring are shown in the thoracic spine. There is some kyphosis.
Case Discussion
As little as 1% of ankylosing spondylitis patients have upper zone fibrosis on chest radiographs. The natural radiographic history is that of reticulonodular opacities becoming confluent. Bullae and cavitation is typical as in this case, therefore mimicking tuberculosis.